<p>Comparison of Characteristics and Clinical Outcomes in 27-Gauge versus 23-Gauge Vitrectomy Surgery</p>

Abstract

Purpose: To compare characteristics, clinical outcomes and complication profiles of a cohort of patients undergoing 27-gauge versus 23-gauge vitrectomy surgery at a tertiary medical center in the Middle East. Methods: This is a retrospective comparative study of indication-matched patients undergoing 27gauge versus 23-gauge pars plana vitrectomy for a set of predetermined diagnoses. Data including indications for surgery, clinical exams, visual outcomes, and complications were documented and analyzed. Results: A total of 22 patients who had 27-gauge pars plana vitrectomy were compared with 44 patients who had 23-gauge surgery for matched indications by a single retina surgeon. Mean follow-up was 14 months after surgery. Indications included macular pucker, macular hole, and vitreous hemorrhage. Both the rate of hypotony at postoperative day 1 and the need for sclerotomy stitching at the end of surgery were significantly more frequent in 23-gauge compared to 27-gauge cases (25% in 23-gauge compared to 0% in 27-gauge (p=0.012) and 18% in the 23-gauge compared to 0% in the 27-gauge (p=0.045), respectively). The mean duration of surgery was similar among groups (35 mins in the 27-gauge group versus 39 mins in the 23-gauge group (p=0.116)), and all eyes achieved anatomic success. In the 27gauge group, best-corrected visual acuity improved from a mean of 20/90 at baseline to a mean of 20/40 at 1 month (p=0.005) and in the 23-gauge group from a mean of 20/95 to 20/ 50 (p=0.001) with no statistical difference between the groups. Conclusion: In this cohort of patients undergoing vitrectomy at a tertiary eye center, the rate of hypotony and the need for sclerotomy suturing were significantly less in the 27-gauge group versus the 23-gauge group. Surgical outcomes were similar in both study groups. The use of the novel 27-gauge instrument system is useful in selected vitreoretinal diseases and appears comparable to the widely used 23-gauge system.

The Clinical and Safety Outcomes of 27 Gauge Pars Plana Vitrectomy in Eyes With Macular Hole

“…None of the eyes in our study developed RRD as reported previously [ 13 , 29 ] so we recommend meticulous complete vitreous shaving with scleral depression. Mean BCVA has significantly improved in our study as reported previously as well [ 15 , 1 ].…”

“…The primary success rate in our study is 93.2% which is comparable to 93.3% reported with the use of 23- and 25-gauge systems [ 28 ]. Yoneda et al [ 29 ] and Saleh et al [ 1 ] have previously reported a 100% primary closure rate with a 27-gauge system; however, their data is limited by its smaller sample size for MH (n=26 and n=4 respectively). The final closure rate in our data either by an extended FDP of one week or after another surgery is 100%.…”

“…Trans-conjunctival micro-incisional vitrectomy surgery (MIVS) is one of the most promising and continuously evolving vitreoretinal surgical procedures used for multiple posterior segment diseases [ 1 ]. Conventional methods utilize 20, 23, and 25 gauge cutters for this purpose [ 2 ].…”

Outcomes of Primary 27-Gauge Vitrectomy for 73 Consecutive Cases With Uveitis-Associated Vitreoretinal Disorders

“…In the cause of uveitis, vitreoretinal lymphoma comprised 30% of all eyes, which is the greatest feature of our cohort and may affect the surgical outcomes as described below. Note that the mean surgical time of 47.1 min in our study is longer than that reported in previous studies (20.2-38.8 min for non-uveitic eyes) (17,18,24). This difference may be attributed to the higher rate of concomitant cataract surgery, the need to educate unexperienced nurses and assistants during surgery, or both.…”

“…This smaller-gauge instrumentation can enhance the advantages of MIVS, such as reduced patient discomfort, minimal scarring, and rapid recovery of vision post-operatively. Thus far, many researchers have reported the feasibility, safety, and efficiency of 27-gauge PPV (17)(18)(19)(20)(21)(22)(23)(24). Given its less invasive nature, 27-gauge PPV should be suitable for vitreoretinal disorders secondary to uveitis.…”